Groups commit to improve CT surgery education

Over the past several years, the specialty of cardiothoracic surgery has experienced a continued decline in enrollment in CT residency training programs. If left unchecked, the result of this decline in qualified residents, combined with the aging of the US population, will be a serious deficit of CT surgeons and restricted access for patients with cardiovascular and thoracic disease. In fact, demand for surgeons currently exceeds the supply, a trend which is predicted to worsen significantly over the next 15 years.

The leaders of the American Association for Thoracic Surgery (AATS), American Board of Thoracic Surgery (ABTS), Society of Thoracic Surgeons (STS), and Thoracic Surgery Foundation for Research and Education (TSFRE) are responding to this crisis by joining forces to create and fund a Joint Council on Thoracic Surgery Education (JCTSE) with the express purpose of changing the current training paradigm and coordinating all thoracic surgery education in the United States.

“Less than 75 percent of CT residency slots have been filled in the last four years, and in 2007 the ABTS examination failure rate was the highest on record,” explained D. Craig Miller, M.D., President of AATS. “A large part of the problem is negative perceptions among medical students regarding the field of cardiothoracic surgery — it takes too long, the job market is saturated, reimbursement is low, and the scope of practice is limited mostly to open surgical procedures, not the exciting high-tech interventional procedures being performed by other specialties.”

The four organizations along with leaders of every major cardiothoracic surgical organization in the U.S. met for two separate strategic retreats in 2007 to address current cardiothoracic surgery training and education in the United States. The outcome of these meetings was the creation of a Memorandum of Understanding (MOU) between the organizations and the development of a job description for an individual Surgical Director of Education to coordinate these efforts and work with the specialty organizations, training programs, and certification organizations.

“In a recent AAMC report, commissioned by AATS and STS, it was concluded that the United States is currently facing a shortage of cardiothoracic surgeons that will grow more severe within the next fifteen years,” said W. Randolph Chitwood, Jr., M.D., President of STS. “The evidence is clear that based on population projections and current CT surgical workforce data, we will not have enough qualified and well-trained cardiothoracic surgeons to treat the growing elderly population that will need CT surgical care.”

It was agreed that the current educational paradigm to train cardiothoracic surgeons must be amended to educate CT surgeons more efficiently, in less time, and in more of the newer technologies. Specific needs identified included: standardize training across all programs to produce higher quality CT surgeons; provide training in the latest techniques, integrate with and use features traditionally in the province of other related disciplines, such as interventional radiology, vascular surgery, and interventional cardiology; broaden the scope of practice of cardiothoracic surgery and the knowledge and content appropriate to cardiothoracic surgery; enhance cardiothoracic surgical resident and post-graduate surgical education; and assess the effectiveness of these educational efforts.

“The JCTSE will work closely with the Thoracic Surgery Directors Association (TSDA), which represents all of the CT training programs,” explained Dr. Chitwood. “The financial backing of the JCTSE will allow us to expand our initiatives to standardize training mechanisms across the specialty to ensure that programs are able to follow the same agenda, incorporating the latest techniques and procedures.”

Inherent in the redesign of CT training and education is the recruitment of the Surgical Director of Education who will be responsible for creation and implementation of the JCTSE’s initiatives. This individual will address the organizational structure and length of training in cardiothoracic surgery, develop templates for alternatives to the traditional general surgery followed by CT surgery residency, including the new integrated six-year residencies, and the combined 4/3 surgery/cardiothoracic surgery programs, and make suggestions for other possible training algorithms. One suggestion is to streamline CT surgical residency training down to six years of dedicated clinical training in cardiovascular and thoracic diseases, incorporating open surgical operations and interventional catheter-based procedures, and eliminate the five years of dedicated general surgery residency which traditionally has been mandatory before entering cardiothoracic surgical residency training.

The JCTSE will closely monitor the new “integrated” CT surgical residency approved by the Residency Review Committee in Thoracic Surgery (RRC-TC) at Stanford University in 2007 and at the University of Pennsylvania in January 2008. “Based on what we are seeing at Stanford in this year’s applicant pool of senior medical students, the shift is attracting very strong, accomplished, talented, and enthusiastic young individuals. We are optimistic that this will create the major sea change necessary to propel the specialty forward,” opined Dr. Miller.

In addition to restructuring the residency training paradigm in the US, the JCTSE will address all levels of cardiothoracic surgical education, including graduate, postgraduate, and continuing education for practicing CT surgeons. The Surgical Director will help to develop postgraduate education with the AATS, STS and other organizations to meet the needs of the practicing CT surgeon, especially in the acquisition of new technology skills and expertise. The Surgical Director will be an ex-officio member of the ABTS, the ABTS Education Committee, the Education and Program Committees of the AATS, the STS Workforces on Clinical Education, Graduate Medical Education and the Annual Meeting, and the Education Committee of the TSFRE. “The coordination of postgraduate education among the organizations will certainly be a great benefit to the specialty,” stated Michael J. Mack, M.D., President of the TSFRE. “A major focus of the Foundation has always been education and we have worked with the STS and AATS in supporting their educational programs. The TSFRE is delighted to be an equal partner in the efforts of the JCTSE to enhance the education of our CT residents and practicing surgeons.”

The Surgical Director will also work with the ABTS to help diplomates meet the requirements for continuing Maintenance of Certifi cation (MOC). “The Director will increase the availability of methods by which CT surgeons acquire new technical skills, partnering with the specialty societies and individually developed courses,” said Richard H. Feins, M.D., Chair of the ABTS. “All of these combined efforts will produce surgeons who are better prepared to take the board certification examination. By joining forces, we hope to maintain the same high quality, well-trained CT surgeon to which we have become accustomed.”

Both the AATS and STS have established outreach programs focused on medical students and general surgery residents, as well. STS invites general surgery residents to its annual meeting and subsidizes their travel. AATS provides summer internships in CT surgery for first- and second-year medical students to spend eight weeks working in a CT surgery department.

The AATS, STS, ABTS, and TSFRE have indicated that they are committed to quality cardiothoracic surgery education at every level. Each of the organizations involved in the JCTSE has pledged major fi nancial and administrative support of these initiatives. “American cardiovascular and thoracic surgery will emerge from this tumultuous time as a stronger, more vibrant specialty,” concluded Dr. Miller.

(Source: AATS 88th Annual Meeting Daily News)